Zoritch B, Roberts I, Oakley A
Children's Unit, St. Peter's Hospital, Chertsey, Surrey, UK.
Soc Sci Med. 1998 Aug;47(3):317-27. doi: 10.1016/s0277-9536(98)00037-9.
Day-care has long been a controversial aspect of social policy in countries such as the U.K. What evidence is there about the effects of out-of-home day-care on educational, health and welfare outcomes for children and their families? This paper applies to day-care studies, the methodology of the systematic review as pioneered in the health care field, in order to establish the evidence-base for day-care provision. Randomised controlled trials of day-care for pre-school children were identified using electronic databases, hand searches of relevant literature and contacts with authors. A total of 8 trials were identified after examining 920 abstracts and 19 books. All the trials were carried out in the U.S.A. European research on this topic is extensive but we did not identify any studies using trial design. Instead observational, case controlled and cohort studies were prominent. The trials were assessed for methodological quality. Results showed that day-care promotes children's intelligence, development and school achievement. Long-term follow up demonstrates increased employment, lower teenage pregnancy rates, higher socio-economic status and decreased criminal behaviour. There are positive effects on mothers' education, employment and interaction with children. Effects on fathers have not been examined. Few studies look at a range of outcomes spanning the health, education and welfare domains. Most of the trials combined non-parental day-care with some element of parent training or education (mostly targeted at mothers); they did not disentangle the possible effects of these two interventions. The trials had other significant methodological weaknesses, pointing to the importance of improving on study design in this field. There is a need for well designed research on day-care to provide an evidence-base for British social policy.
在英国等国家，日托服务长期以来一直是社会政策中一个颇具争议的方面。关于家庭外日托服务对儿童及其家庭的教育、健康和福利结果有哪些证据呢？本文将医疗保健领域首创的系统评价方法应用于日托服务研究，以建立日托服务提供的证据基础。通过电子数据库、对相关文献的手工检索以及与作者的联系，确定了针对学龄前儿童日托服务的随机对照试验。在查阅了920篇摘要和19本书籍后，共确定了8项试验。所有试验均在美国进行。欧洲关于这一主题的研究广泛，但我们未发现任何采用试验设计的研究。相反，观察性研究、病例对照研究和队列研究较为突出。对这些试验进行了方法学质量评估。结果表明，日托服务能促进儿童的智力、发展和学业成绩。长期随访显示就业增加、青少年怀孕率降低、社会经济地位提高以及犯罪行为减少。对日托服务对母亲的教育、就业和与孩子的互动有积极影响。尚未考察对日托服务对父亲的影响。很少有研究关注涵盖健康、教育和福利领域的一系列结果。大多数试验将非父母日托服务与某种家长培训或教育元素（大多针对母亲）相结合；它们没有区分这两种干预措施可能产生的影响。这些试验还存在其他重大的方法学弱点，这表明在该领域改进研究设计的重要性。需要开展精心设计的日托服务研究，为英国的社会政策提供证据基础。
